Medication Treatment for Failed Back Surgery Syndrome

Medication management may include medical marijuana to treat FBSS symptoms.

Over-the-counter (OTC) drugs and prescription medications may be part of your multidisciplinary plan to treat failed back surgery syndrome (FBSS) pain and related symptoms. Included, is information about the growing use of medical marijuana for FBSS pain.

medication management of over-the-counter and prescription drugsThe type of medication (over-the-counter, prescription) your doctor recommends depends on the underlying cause of your back or neck pain and related symptoms. Photo Source: 123RF.com.

What Medicines Help Ease Failed Back Surgery Pain and Symptoms?

The type of medication(s) your doctor recommends or prescribes depends on the underlying cause of your back or neck pain and related symptoms. For example, if you developed nerve pain after spine surgery, your doctor may prescribe an anticonvulsant drug like gapapentin to ease that symptom.

Listed below in alphabetical order, are some common types of OTC drugs and prescription medications used to manage pain and symptoms of FBSS.

Acetaminophen: This relatively safe OTC pain reliever is among the most common first-line treatments for back or neck pain. Since many medications for pain include acetaminophen, patients should be careful not to take multiple medications with acetaminophen since accidental overdose is very serious. Brand name example: Tylenol.

Anticonvulsants: For nerve-related pain (eg, neuropathic pain, radiculopathy), your doctor may prescribe an anticonvulsant drug to reduce that type of pain. These drugs were initially discovered for use in epilepsy but have also been found to have some benefit to people with nerve related pain. Brand name examples: Neurontin, Lyrica.

Antidepressants: Antidepressants do more than treat depression: They also help to improve sleep quality and may reduce muscle and nerve pain related to failed back surgery syndrome. Different types of antidepressants are available, including:

  • Tricyclic antidepressants: Brand names include Elavil, Pamel.
  • Selective serotonin reuptake inhibitors (SSRIs): Brand names include Prozac, Zoloft.
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs): Brand names include Cymbalta, Savella.

Muscle relaxants: This class of prescription medicine are given to ease muscle spasm and muscle pain. In some cases, the doctor will recommend first trying acetaminophen or a non-steroidal anti-inflammatory drug before moving on to a muscle relaxant. Brand name examples: Lioresal, Soma.

Non-steroidal anti-inflammatory drugs (NSAIDs): These pain- and inflammation-relieving drugs are available in both OTC and prescription forms, depending on strength and side effects. One type of prescription NSAID—known as a COX-2 inhibitor (eg, brand name Celebrex)—claims a lower risk of stomach problems compared to other NSAIDs. Brand name examples: Advil, Motrin, Aleve.

Opioids: This class of pain-relieving controlled drugs include fentanyl (synthetic opioid), oxycodone, hydrocodone, codeine, and morphine. Opioids interact with receptors in the brain that help control pain. Increasing realization that opioids have addictive properties and serious side effects has led to decreased opioid use for chronic pain. Opioids are appropriate for only very short-term use and/or patients with terminal illness. Brand name examples: Actiq, Norco, Percocet, OxyContin.

Topical pain relievers: While most pain medications are taken orally (by mouth), your doctor may recommend topical medications—creams, ointments, sprays, gels, and patches—to ease inflammation and nerve pain. Topical pain relievers are available in both OTC and prescription forms. Common prescription brand name: Lidoderm.

The Growing Use of Medical Marijuana for Failed Back Surgery Syndrome Pain

Increasingly, medical marijuana and cannabinoids (ie, chemicals found in marijuana) are being used to manage pain—and people who suffer from FBSS may find that it helps ease their chronic back or neck pain.

According to the National Institute on Drug Abuse, medical marijuana is the use of the whole, unprocessed marijuana plant or its extracts to treat pain and other symptoms.1 While many U.S. states have legalized medical marijuana, the U.S. Food and Drug Administration (FDA) does not approve or recognize marijuana for medicinal purposes.

However, the FDA has approved two cannabinoids to treat two rare forms of epilepsy (Lennox-Gastaut syndrome and Dravet syndrome). These cannabinoids, dronabinol and nabilone, are available as a pill.

medical marijuana, cannabinoids, pillsMore research showing that medical marijuana’s benefits outweigh its risks may lead to new uses for medical marijuana and perhaps open the door to FDA approval. Photo Source: 123RF.com.

While only two cannabinoids are approved by the FDA for narrow treatment uses, the cannabinoids THC (which is responsible for the drug’s “high”) and cannabidiol (CBD) may also provide pain-relieving benefits. Moreover, some research has suggested that medical marijuana legalization had led to fewer opioid prescriptions and deaths.1

More research showing that medical marijuana’s benefits outweigh its risks may lead to new uses for medical marijuana and perhaps open the door to FDA approval. For now, states that have legalized marijuana require patients to provide a prescription or written recommendation from a doctor to a marijuana dispensary. Also, patients must have a diagnosis that qualifies for medical marijuana treatment (states mandate what diagnoses qualify). Some states also require patients eligible to receive medical marijuana have a medical marijuana identification card.

Will Medications Alone Treat My Failed Back Syndrome Pain?

In most cases, medications alone are not enough to address pain and symptoms of FBSS. Failed back surgery syndrome often is a complex condition and requires a multidisciplinary treatment approach. A multidisciplinary approach involves combining one or more specialist treatments with medication management—such as passive and active physical therapy, psychological care, and interventional procedures—spinal injections, spinal cord stimulation and intrathecal drug delivery.

Updated on: 02/06/19
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How Physical Therapy Treats Failed Back Surgery Syndrome

Physical therapy or physiotherapy is often part of a multidisciplinary program to treat failed back surgery syndrome, FBSS. Treatment includes passive and active therapies to help manage back pain and other symptoms
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